Reg 25318.doc

REGULATIONS ABOUT HEALTH UNITS FOR PLACES OF EMPLOYMENT AND WORKING CONDITIONS & PRINCIPLES OF OFFICE MEDICAL DOCTORS

PART ONE

Aim, Content, Support and Definitions Aim

Article 1 - This regulations aims to specify organization, structuring and working conditions of Health Units for Places of Employment and requirements, quantity, duties, responsibilities, training and working conditions of office medical doctors.

Content

Article 2 - Articles of this regulations is valid for places of employment employing at least fifty permanent workers, mentioned at Labor Law dd 22/05/2003 numbered 4857.

Support

Article 3 - This regulations is prepared under support of labor law dd 22/05/2003, numbered 4857, article 81, which is valid through being published at the official gazette, numbered 25134 on 10/06/2003.

Definitions

Article 4 - Definitions in these regulations are:

Ministry: Ministry of Labor and Social Security

General Directorate: General Directorate of Labor Health and Safety

SSK: Social Security Institution

Labor Health Services: Health care of employees, preventive medical services, improvement of health, first aid and urgent care.

Health Unit: Unit, qualified to run labor health services with necessary equipment at the place of employment.

Common Health Unit: Health Unit established to serve more than one place of employment.

Office doctor: Certified medical doctor by the ministry.

Office Nurse/Health Officer: Certified Nurse of Health Officer by the ministry.

PART TWO

General Conditions Responsibilities of Employers Article 5 - Employers are obliged to establish a health unit if they employ more than fifty employees. Employers are obliged to; establish a healthy and safe environment, prevention of health security risks and running of preventive services, obtaining necessary precautions, for the healthy running of these precautions, employing one or more medical doctors and personnel as well as a health unit. Employers are obliged to inform employees with the name, address, working hours and responsibilities of the office doctor. Employers provide office doctors with the necessary equipment to run his/her business safely and support him/her for the following of medical improvements. Employer is responsible for the running of health services at the place of employment.

Rights and Responsibilities of Employees

Article 6 - Employees and representatives are obliged to; follow procedures for a healthy environment, support heath unit services, attend training programs and check-up activities and cooperate when necessary.

Employees and representatives can vote for the decisions at the organizations for health care at the place of employment. Employees and representatives are informed prehand about the aims and methods of health care services. Employees have the right for objection to their health inspection results and are informed by the employer for these procedures.

PART THREE

Structure and Working Conditions of Health Unit

Health Unit

Article 7 - Employment of at least one office doctor and a nurse/health officer at the health unit is an obligation. Health unit should be located preferably at a one story building or at the entrance of place of employment, big enough to locate the necessary equipment and personnel and easy to contact. Health unit must contain at least one examination room, one interference room, one waiting room and a room for the personnel. Lighting, ventilation and air conditioning must be good enough and the floor must be easy to clean. Health unit is equipped with the equipment mentioned at annex 1. Health units kept open during the working hours of place of employment. At least one nurse/health officer, or if both unavailable one person capable of making first aid is kept employed at the health unit.

Annual Work Plan

Article 8 - Health unit prepares an annual work plan mentioning services to be run by the unit and asks for the approval of employer. Approved plan is announced at the place of employment’s well this plan is announced to the representatives of employees and if exists to the committee of labor health and safety.

Annual Evaluation Report

Article 8 - Health unit prepares an evaluation report - as in annex 2 - to be examined by health inspectors and delivers a copy to general directorate.

Principle of Confidentiality

Article 10 - Health unit has to obey the principle of confidentiality about medical, technical and administrative information of employees and place of employment.

Cooperation Article 11 - Health unit works in cooperation with other departments, committee of labor health and safety and representatives of employees. Health unit works in close cooperation with the health related units of ministry and other related institutions. Health unit takes place in the national organizations about labor safety and health and works in cooperation with related authorities. Health unit works in cooperation with related institutions about precautions to be taken during natural disasters.

First Aid and Urgent Medical Treatment

Article 12 - Health unit organizes and runs first aid and urgent medical treatment cases for the employees and employer. As well cooperates with other institutions when necessary.

Information and Training

Article 13 - Health Unit provides consulting and training services to employer, employees, representatives of employees about labor health and related subjects. Health unit has to inform and ask for approval of employees for every kind of service to be provided.

Registration and Statistics

Article 14 - All information about working environment and employees' health conditions are registered and documents are kept safe. Health conditions, duties and environmental conditions of employees are preserved in personal health files. Health unit is obliged to keep these files for ten years after employee is resigned. Mentioned keeping time of files may be prolonged for places of employment which have the risk of occupation illness. In case employee changes place of employment, new employer asks for the personal health file of the employee and ex-employer delivers a controlled copy of the file. Duties to be given and working conditions are mentioned in the check-up report of the employee and result of the report is announced verbally to the employer and employee. For the registration and following of occupation illnesses and labor accidents, documents mentioned in annex 3 - 4 are used. All occupation illnesses and accidents are registered. Sources of these illnesses and accidents are cleared and preventing actions are taken.

Medical Treatment Services Article 15 - Methods exempting labor health services are decided according to a protocol signed between employer and SSK.

Activity Zone of Health Unit

Article 16 - Health unit is responsible for determination of chemical and physical risks, taking necessary precautions, and making needed measurements for prevention of mentioned risks. A health unit personnel works in cooperation with labor safety expert for running these services.

Common Health Unit

Article 17 - Employers can establish a common health unit or be a partner to a pre-established unit. Common health unit can be established for a few places of employment activating the same business or can be established for small industrial zones activating at different businesses. Quantity and qualifications of personnel for common health unit is determined according to labor risks and total quantity of employees as well as other criteria mentioned in this regulations. Serviced employers cover expenses of common health unit.

PART FOUR

Qualifications, Duties, Responsibilities, Training, Working Conditions and Employment of Office Doctor

Qualifications of Office Doctor Article 18 - Doctors to be employed, as an office doctor has to be certified as an office doctor by the ministry.

Certification Article 19 - The ministry gives Office doctor certificate to doctors:

a. Who worked as a labor inspector or owns scientific doctorate of labor health or labor illnesses sub-branch expert or office doctor sub-branch expert.

b. Who attend certification training programs and honored successful by the end of these programs.

Training and Examination Article 20 - Preparation, practice, formation of exam committee and running of examination of certification training programs of office doctors, are determined by Training Commission of Office Doctors. Duration of the training cannot be less than 180 hours including theoretical and practical training.

Commission is formed by a doctor labor inspector from labor Inspection Committee, one member from each of Ministry of Health, Research and Training Center for Labor and Social Security, General Directorate for Health Affairs of Social Security Institution, Turkish Doctors Association and a lecturer from a university who made studies about labor health charged by Higher Education Council, all under presidency of General Director to Labor Health and Safety.

Commission is held every year in January. When necessary ministry can call the commission for urgent meeting. Agenda of the meeting is announced to members 15 days prior to the meeting. General Directorate organizes secretarial works of the commission.

Absolute majority takes decisions. In case of equality, vote of the president determines the decision. Decision of the commission is reported in the judgment book and signed by members.

Labor and Social Security Training and Research Center (ÇASGEM) run certificate training program and examination determined by the commission.

Office doctors are re-trained periodically.

Duration of Employment for Office Doctors Article 21 - Office doctors are employed as following durations in order to maintain the duties mentioned in this regulations:

1st risk group places of employment; at least 1 workday/month

2nd risk group places of employment; at least 2 workdays/month

3rd risk group places of employment; at least 3 workdays/month

4th risk group places of employment; at least 4 workdays/month

5th risk group places of employment; at least 5 workdays/month

30 minutes per employee per year is added for periodical health controls.

In case there is a medical treatment service at the place of employment, the duration needed for this service is exempted from a.m. duration.

The risk group of places of employment is determined by a commission formed by a member from each of Ministry of Health, Ministry of Industry, Directorate of Social Security Institution, Labor Inspection Commission Directorate, Labor Unions Federation, Employers Unions Federation, Turkish Doctors Association and Chamber of Architects and Civil Engineers all under presidency of General Director for Labor Health and Safety in February, by the ministry.

When necessary ministry can call the commission for urgent meeting. Agenda of the meeting is announced to members 15 days prior to the meeting. General Directorate organizes secretarial works of the commission.

Absolute majority takes decisions. In case of equality, vote of the president determines the decision. Decision of the commission is reported in the judgment book and signed by members.

Duties of Office Doctor

Article 22 - Office Doctor is obliged to perform following duties. Attendance and periodical check-up of employees is held according to annex 5:

a. Attends labor health and safety commission and makes necessary expiations for a healthy labor environment. Consults for decisions and follows the practicing of decisions taken by the commission.

b. Follows closely pregnant employees, younger than eighteen years olds, mothers with babies younger than two years old, suspected occupation illness having employees, employees with chronic illnesses, alcoholics, drug addicts, and the ones who had more than one job accidents.

c. Prepares reports for employment of the disabled or performs medical inspection for ex-sentenced people.

d. Performs medical inspection for the ones who had job accidents and could not work for more than three weeks.

e. Performs necessary action for employees having chronic illnesses.

f. Performs necessary laboratory inspections and radiological inspections.

g. Organizes first aid activities and enables necessary training for the related personnel.

h. Performs controlling of spread diseases.

i. Controls health conditions of breast-feed room and kindergartens, performs medical inspection for children of the employees.

j. Performs action for health of pregnant employees.

k. Examines periodically materials used at the place of employment and takes necessary precautions for a possible destruction.

l. Makes necessary measurements in order to keep a healthy working environment.

m. Performs necessary actions for general hygienic conditions, healthy and good enough food, good drinking water, clean toilets and dressing rooms.

n. Performs examinations to keep employees health safe and lower stress agents in the work environment.

o. Checks and follows any occupation illness cases and works in coordination with SSK Occupation Illnesses Hospitals.

p. Performs inspections and investigations to prevent occupation illnesses.

q. In case an employee had an accident, when he/she restarts work, determines appropriate occupation for the employee.

r. Performs action for re-employment of employees who had occupation illness or accident.

s. Acts for adaptation of ex-sentenced or disabled.

t. Performs training activities for directors, labor health commission members, employees and reprehensive.

u. Performs activities for employees to drive them away from stress.

v. Reports health inspection activities and prepares annual work report according to annex 6 and delivers to labor health and safety commission.

Authorities of Office Doctor Article 23 - Office doctor can no way be hindered performing his duties mentioned in these regulations. Office doctors perform their works freely and according to ethics as well as deontology principles. When he sees a close danger for the employees, immediately warns the management and stops work if necessary. Performs necessary action for inharmonious employees with there work and enables them to have a fitting occupation. Advices to production planning about labor health. When necessary, can perform discussions or conversations with any employee in any department. If seen necessary, cooperates with related institutions about this matter.

Responsibilities of Office Doctor

Article 24 - Office doctor is responsible for confidentiality of place of employment and health files, as well as creating a healthy working environment, while performing his duties mentioned in these regulations.

Employment of Office Doctor

Article 25 - Employer make a contract with the doctors who have required qualifications according to these regulations. One controlled copy is delivered to the ministry.

Doctors for private institutions can have a part time work at a workplace if permitted by chamber of doctors. Agreement is done according to sample in annex 7. At risk groups I, II, and III employing 1000 workers, a full time doctor is employed. If the number of workers exceeds 1000 the required number of additional doctor(s) are employed.

Risk groups IV and V employing 750 workers must employ a full time doctor. If it exceeds 750 article 21 of this regulation is applied and the required number of additional doctor(s) will be hired.

Liability of Notice

Article 26 - In case contract is null for any reason notice is given to the ministry in three work days' time.

PART FIVE

Qualifications, Duties, Training and Employment of Nurse and Health Officer Article 27 - Those persons are required to have certificate of office nurse or health officer awarded by the ministry.

Certification Article 28 - Office nurse or health officer certificate is awarded by the ministry to:

a. M.B.A. public health nurses or health officers

b. Graduates of B.A. nurses or health officers who attended training programs and passed successfully all examinations organized by the ministry.

Training Article 29 - Office nurses or health officers training commission hold Regulations about certificate programs. Commission is formed by a doctor labor inspector charged by Labor Inspection Committee, a doctor or a nurse from labor health and safety center, Ministry of health, labor and social security research and development center, social security institution, Turkish nurses association, and a lecturer from a university who has studies about labor health and all presented by labor health and safety general director. When necessary ministry can call the commission for urgent meeting. Agenda of the meeting is announced to members 15 days prior to the meeting. General Directorate organizes secretarial works of the commission. Absolute majority takes decisions. In case of equality, vote of the president determines the decision. Decision of the commission is reported in the judgment book and signed by members.

Duties of Office Nurse and Health Officer Article 30 - Duties of Office Nurse and Health Officer are mentioned as follows:

a. Assists office doctors for duties to perform and determination of problems in the place of employment.

b. Gathers information about employee’s health conditions, register’s and assists office doctor during medical treatments.

c. Diverts suspected cases to office doctor.

d. Follows pregnant employees, attends planning, running and follow-up of childcare services.

e. Follows employees illnesses, reports to office doctor.

f. Performs necessary reporting activities about assisting health services, evaluation following and reporting with advices of office doctor.

g. Assists office doctor for performing of first aid activities.

h. Acts as a trainer for training of employees.

Employment of Office Nurse or Health Officer Article 31 - At least one nurse or health officer is employed as full time employee. Additionally:

a. For 1st, 2nd and 3rd risk groups, for every 500 employee, one nurse or health officer is full time occupied.

b. For 4th and 5th risk groups, for every 350 employees, one nurse or health officer is full time occupied.

PART SIX

Last Commands Free of Charge Services Article 32 - Services provided by health unit is free of charge for employees.

Abrogated Regulations Article 33 - Regulations about "working conditions, duties and responsibilities of office doctors" published at the official gazette on 04/07/1980 numbered 17037 is abrogated.

Temporary article 1 - Office doctor certificates awarded before publication of this regulations is valid.

Validity Article 34 - This regulation comes into force at the date of published.

Execution Article 35 - Minister of Labor and Social Security execute Articles of this regulation.

ANNEX-1

HEALTH UNIT EQUIPMENT LIST

A) Medical Equipment:

1. Sphygmomanometer

2. Stethoscope

3. Ophthalmoscope

4. Otoscope

5. Ear washer

6. Abelard

7. Thermometer

8. Medical sewing set(obligatory at full time M.D.employing workplaces)

9. Bandage equipment

10. Injection equipment

11. Scale

12. Inspection desk

13. Curtain

14. Medicine cupboard

15. Medical equipment cupboard

16. Stretcher

17. Oxygen tube

18. Refrigerator

A) Office equipment:

1. Computer

2. Table and armchair

3. Patient chair

4. Stationary

5. File board

A) Vehicle:

At workplaces employing more than 50 workers and heavy work is performed, a vehicle must be ready 24 hrs for emergency.

ANNEX-2

ANNUAL EVALUATION REPORT FOR HEALTH UNIT

Name of company

Register No.

Address

Tel and Fax

E-mail

Business category

No of employees

Men:

Women:

Practicer:

Works performed

a) Risk analysis

b) Measurements

c) Entry check ups

d) Periodical controls

e) Biological analyses

f) Physical tests

g) Training

h) First aid and emergency

i) Other works

……./……./2004 Date

M.D.

Signature

ANNEX-3

JOB ACCIDENT FORM

File No

Workplace register No

Job classification code

Address

SS no

Date and place of birth

Sex

Duty and dept.

Work duration in this workplace

Schedule and shifts

Date and hour of accident

Reason of accident

Destruction caused by accident

Disability time and condition

Result

…/…/2004

Date

Labor safety expert M.D.

ANNEX-4

FORM FOR OCCUPAIONAL ILLNESS

FÝLE No

Workplace register No

Job classification code

Address

W

O

R

K

E

R’

S

Name-surname

SS no

Date and place of birth

Sex

Duty and dept.

Job history

Duration of work in this workplace

Diagnosis

Date of diagnosis

Reason for illness

Disability time and condition

Rest duration at health unit

Result

MEDICAL ANAMNESIS

1- Have you suffered from following in last one year?

Phlegm cough

Asthma

Chest pain

Palpitation

Back ache

Diarrhea-constipation

Pain in bones

2- Have you had following illnesses in the last one year?

Heart illness

Diabetics

Kidney illness

Hepatitis

Stomach ulcer

Loss of hearing

Seeing disorder

Neurological illness

Skin disease

Food poisoning

3. Have you been to a hospital in last one year?

4. Have you had a serious operation in last one year?

5. Have you had a job accident in last one year?

6. Have you been to Job Illnesses Hospital in last one year?

7. Have you had compensation in last one year?

8. Are you having a cure now?

9. Do you smoke?

…………Month/year ago

…………Months/years smoked

…………Cigarettes/day smoked yes

Since…………months/years

…………Cigarettes/day

10. Do you use alcohol?

…………Years

Drunk…………years

…………How after yes

Since…………years

…………How often

PHYSICAL CHECK RESULTS:

A)- senses

Eye

Ear-nose-throat

Skin

B)- cardiologic check

C)- respiration system check

D)- digestion system check

E)- Ürogenital system check

F)- muscles-bones check

G)- Neurological check

H)- Psychiatric check

İ)- other

-BP / mmHg

-Pulse: /min.

- Height: weight: BMI:

LAB RESULTS.

A)- Biological analyses

Blood

Urine

B)- radiological analyses

C)- Physical analyses

Odometer

SFT

D)- Psygolocgical tests

E)- other

RESULT

1. Can work at ……………………………………workplace/dept.

2. If defects mentioned in the report are cured person can work.

Sign date

ANNEX – 6

HEALTH UNIT ANNUAL REPORT

Analyses Biochemical

Analyses

JOB START

Periodical

Policlinic

Other

TOTAL

Doctor

ANNEX-7

AGREEMENT FOR DOCTORS

WORKPLACE:

Name:

Address

Tel:

Fax

E-mail

Region register no for ministry of labor and social security

SSI no

Work category

Risk group

Number of employees

Doctor’s:

Name-surname

Diploma No:

Certificate No:

Expertise area

Duration of work

Address

Tel:

Fax

E-mail

Previous Workplaces of doctor:

Special commands:

Employer

Doctor